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Quiz Session - Attempts With Random Questions

AACN PCCN NOV 2023 Exam Hanbook version 1.1.1 Exam Questions

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81.

In a positive-pressure ventilator, which mode of ventilation ensures that a predetermined number of breaths at a selected Vt are delivered each minute, and any additional breaths initiated by the patient are also delivered by the ventilator?

  • Assist-Control (AC) ventilation

  • Synchronized Intermittent Mandatory Ventilation (SIMV)

  • Spontaneous ventilation

  • Control ventilation

Correct answer: Assist-Control (A/C) ventilation

The AC mode of ventilation ensures that a predetermined number of breaths at a selected Vt is delivered each minute. Any additional breaths initiated by the patient are also delivered by the ventilator. This provides full ventilatory support for every breath, whether it is initiated by the ventilator or the patient.

In contrast, the SIMV mode allows spontaneous breathing without delivering additional breaths initiated by the patient. The ventilator delivers a predetermined number of breaths at a selected Vt each minute but does not support additional breaths initiated by the patient.

In spontaneous ventilation, all breaths are initiated and controlled by the patient without any mandatory breaths or support from the ventilator.

In control ventilation, the ventilator delivers a fixed number of breaths at a selected Vt each minute, with no allowance for spontaneous breathing by the patient.

82.

Which of the following statements about hospital-acquired pneumonia is TRUE? 

  • Most cases are due to aspiration of bacteria that colonize the upper gastrointestinal tract or oropharynx

  • Most cases are caused by hematogenous spread of an organism to the lung from another site in the body

  • Most cases are caused by inhalation of particles or aerosols containing organisms

  • Most cases are caused by a decreased level of consciousness and mechanical ventilation

Correct answer: Most cases are due to aspiration of bacteria that colonize the upper gastrointestinal tract or oropharynx

Hospital-Acquired Pneumonia (HAP) most commonly results from the aspiration of bacteria that colonize the oropharynx and upper gastrointestinal tract. These bacteria are often introduced into the lower respiratory tract when a patient's normal protective mechanisms, such as coughing or ciliary movement, are impaired, which is common in hospitalized patients.

Hematogenous spread to the lung is less common and is typically associated with severe systemic infections or bacteremia, rather than being the primary cause of HAP.

While inhalation of infectious aerosols can lead to pneumonia, it is not the primary route for HAP, which is more often associated with aspiration.

While a decreased level of consciousness and mechanical ventilation can increase the risk of developing hospital-acquired pneumonia, particularly Ventilator-Associated Pneumonia (VAP), they are not the direct cause. The primary cause remains the aspiration of bacteria colonizing the upper gastrointestinal tract or oropharynx.

83.

What longer-acting synthetic analog of somatostatin produces the same results as vasopressin in the control of acute variceal bleeding, but with significantly fewer adverse effects? 

  • Octreotide

  • Propranolol

  • Pantoprazole

  • Ibutilide

Correct answer: Octreotide

Octreotide is a synthetic analog of somatostatin, which inhibits the release of several gastrointestinal hormones and reduces splanchnic blood flow. This effect helps to control acute variceal bleeding similarly to vasopressin. However, octreotide is preferred due to its longer duration of action and lower incidence of systemic adverse effects compared to vasopressin. It is commonly used in conjunction with other therapies, such as endoscopic band ligation, to manage variceal bleeding effectively.

Propranolol is a beta-blocker that treats high blood pressure, angina (chest pain), irregular heartbeat, migraine headaches, and tremors and lowers the risk of repeated heart attacks.

Pantoprazole is a Proton Pump Inhibitor (PPI) that treats Gastroesophageal Reflux Disease (GERD) and damage to the esophagus. It also treats high levels of acid in the stomach caused by a tumor (such as Zollinger-Ellison syndrome).

Ibutilide is an antiarrhythmic that is indicated for conversion of recent-onset atrial fib and atrial flutter to normal sinus rhythm. It is associated with minimal hemodynamic effects and has not been shown to worsen heart failure or to lower blood pressure.

84.

Caution must be taken NOT to diurese a heart failure patient too fast, as rapid loss of fluid can lead to what condition?

  • Hypotension

  • Decreased renal perfusion

  • Acute kidney injury

  • Electrolyte imbalances

Correct answer: Hypotension

Rapid diuresis in a heart failure patient can lead to a sudden decrease in intravascular volume, which may cause a drop in blood pressure (hypotension). This is particularly dangerous in heart failure patients, as their cardiovascular system is already compromised. Monitoring fluid balance carefully and adjusting diuretic therapy accordingly is critical to avoid hypotension and maintain adequate organ perfusion.

While decreased renal perfusion can occur, it is often a consequence of hypotension and is not the primary concern with rapid fluid loss.

Acute kidney injury could be a complication if renal perfusion decreases significantly, but it is typically a secondary issue following hypotension.

Electrolyte imbalances, especially regarding potassium and sodium levels, are a concern with diuresis, but hypotension due to rapid fluid loss is the most immediate and dangerous risk.

85.

A 70-year-old patient with a history of heart failure and bradycardia is in the Progressive Care Unit (PCU) after the implantation of a permanent pacemaker. On the telemetry monitor, you observe paced ventricular beats at a rate of 70 bpm, occasional non-paced intrinsic beats, and no signs of malfunction. 

Which of the following statements is TRUE about this patient’s pacemaker function?

  • The pacemaker is in demand mode, pacing only when the heart rate falls below the set rate

  • The pacemaker is in asynchronous mode, pacing regardless of intrinsic activity

  • The pacemaker is malfunctioning and needs immediate reprogramming

  • The pacemaker is oversensing and not delivering appropriate pacing

Correct answer: The pacemaker is in demand mode, pacing only when the heart rate falls below the set rate

Demand mode (synchronous pacing) means the pacemaker senses the patient’s intrinsic heart activity and delivers pacing impulses only when the heart rate falls below the programmed rate. This fits the scenario as the described telemetry indicates proper sensing and pacing.

In asynchronous mode (fixed-rate pacing), the pacemaker delivers impulses at a set rate regardless of the patient’s intrinsic heart activity. However, in this case the presence of occasional non-paced intrinsic beats indicates the pacemaker is sensing intrinsic activity.

The pacemaker is not malfunctioning; the description indicates it is functioning correctly by pacing at the set rate and allowing intrinsic beats when they occur.

Oversensing occurs when the pacemaker incorrectly senses extraneous signals as intrinsic activity, leading to inappropriate inhibition of pacing. In this scenario, the pacemaker is pacing appropriately and there is no evidence of over-sensing.

86.

A 38-year-old female patient with cardiogenic shock is not responding to dobutamine. Her blood pressure remains low, and she develops worsening pulmonary edema. 

Which of the following interventions is NOT one you should consider?

  • Increasing fluid administration

  • Intra-Aortic Balloon Pump (IABP)

  • Left Ventricular Assist Device (LVAD)

  • Mechanical ventilation

Correct answer: Increasing fluid administration

Increasing fluid administration would worsen pulmonary edema in a patient with cardiogenic shock, as the primary issue is poor cardiac contractility, not fluid deficit. Careful fluid management is critical in these patients.

An IABP is often used to reduce afterload and improve coronary perfusion in patients with cardiogenic shock. An LVAD can provide mechanical support for patients with severe cardiogenic shock who are not responding to medical management. Mechanical ventilation is necessary if the patient develops respiratory failure or severe pulmonary edema secondary to cardiogenic shock.

87.

In an Electrocardiogram (ECG), which wave represents ventricular muscle repolarization? 

  • T wave

  • P wave

  • U wave

  • ST segment

Correct answer: T wave

The T wave represents ventricular muscle repolarization and typically follows the QRS complex. It is usually in the same direction as the QRS complex, although this can vary depending on multiple factors, such as myocardial disease, ischemia, electrolyte levels, and drug effects. It can be upright, flat, or inverted.

The P wave represents the electrical depolarization of the atria of the heart.

The U wave is a small deflection that may follow the T wave, and it is associated with the repolarization of the Purkinje fibers or the last phase of ventricular repolarization. It is not always present on an ECG and is often more prominent in certain conditions, such as hypokalemia.

The ST segment represents the interval between the end of ventricular depolarization (end of the QRS complex) and the beginning of ventricular repolarization (start of the T wave). It reflects the period of time when the ventricles are depolarized and no electrical activity is happening, which corresponds to early ventricular repolarization.

88.

Which of the following statements about peritoneal dialysis is FALSE?

  • With an optimally functioning catheter, it takes approximately one hour for 2 L of fluid to infuse

  • During peritoneal dialysis, dialysate flows into the peritoneal cavity by gravity

  • In peritoneal dialysis, diffusion and convection occur across the peritoneal membrane

  • Peritoneal dialysis is contraindicated in patients with respiratory distress

Correct answer: With an optimally functioning catheter, it takes approximately one hour for 2 L of fluid to infuse

Dialysate flows into the peritoneal cavity by gravity; it takes approximately ten minutes for 2 L of fluid to infuse.

The dialysate remains in the cavity for a predetermined amount of time (dwell time) and then is drained. During the dwell time, diffusion and convection occur across the peritoneal membrane. Peritoneal dialysis is contraindicated in patients who have recently undergone abdominal surgery and in those with respiratory distress, abdominal infection, or bowel diseases.

89.

Regarding informed consent, an accurate tool for measuring a patient's capacity is based on:

A. The patient's ability to concur with healthcare providers

B. The patient's ability to concur with family members

C. The patient's religious and cultural beliefs and values

D. The patient's abilities as a decision-maker

E. The consistency with which the patient states their preferences

  • D, E

  • A, B, D, E

  • C, D, E

  • D

Correct answer: D, E

The patient's abilities as a decision-maker and their consistency in addressing issues determine their capacity to make decisions.

Capacity is not based on the ability to concur with healthcare providers or family members. Cultural, religious, or ethical differences should not be misinterpreted as evidence of incapacity.

90.

A nurse manager notices that several nurses in the unit exhibit signs of moral residue, such as disengagement and emotional exhaustion, after participating in ethically challenging cases. 

Which of the following is the MOST likely contributing factor to this situation?

  • Lack of ethical support and guidance

  • Overwhelming patient workload

  • Inadequate clinical skills

  • Poor communication among team members

Correct answer: Lack of ethical support and guidance

When nurses do not have access to resources like ethics consultations, debriefing sessions, or supportive leadership, they are more prone to experiencing unresolved moral conflicts, leading to moral residue.

Overwhelming patient workload can contribute to burnout but is less directly related to the specific feelings of moral residue that stem from unresolved ethical conflicts. Inadequate clinical skills may lead to stress but do not directly cause moral residue, which is more related to ethical dilemmas than to clinical incompetence. Poor communication among team members can exacerbate workplace stress but is not the primary cause of moral residue, which is rooted in ethical challenges.

91.

A 49-year-old male patient with uncontrolled hypertension is hospitalized for a stroke. You identify that his current care plan does NOT align with the most recent evidence on managing hypertension in stroke patients. 

What should you do FIRST to engage in clinical inquiry?

  • Review the latest research on hypertension management

  • Speak with the patient's family about the care plan

  • Request a medication review from the pharmacy

  • Contact the physician to discuss alternative treatments

Correct answer: Review the latest research on hypertension management

Clinical inquiry starts with gathering and reviewing the most recent evidence related to the patient's condition. You should seek updated guidelines or research to ensure that the patient’s care aligns with the best available evidence.

Speaking with the patient's family is important for care coordination, but it does not directly address clinical inquiry, which focuses on reviewing evidence. Requesting a medication review is more of a clinical task than an inquiry-based approach. Before requesting a medication review, you should review the evidence to see whether changes are warranted. Contacting the physician may be necessary, but you should be equipped with evidence-based information before making recommendations or discussing changes to treatment.

92.

You are caring for a 32-year-old male patient in the Progressive Care Unit (PCU) five days post-gastric sleeve surgery. The patient complains of severe abdominal pain, shoulder pain, fever, and chills. What complication should you suspect? 

  • Anastomotic leakage

  • Gastrointestinal bleeding

  • Bowel obstruction

  • Pulmonary embolism

Correct answer: Anastomotic leakage

Anastomotic leakage is a serious complication after gastric sleeve surgery and presents with symptoms such as severe abdominal pain, shoulder pain (referred pain due to diaphragmatic irritation), fever, and chills. The initial nursing action should include assessing vital signs to determine the patient's stability and preparing for diagnostic imaging (such as a CT scan) to confirm the diagnosis and guide further treatment.

Gastrointestinal bleeding can present with symptoms like hypotension, tachycardia, and blood in the stool or vomit. However, it does not typically cause severe abdominal pain, shoulder pain, fever, and chills.

While bowel obstruction can cause severe abdominal pain, it is less likely to present with fever and chills. The symptoms described are more consistent with an anastomotic leak.

Pulmonary embolism can present with sudden shortness of breath, chest pain, and signs of hypoxia, but it does not typically cause severe abdominal pain, shoulder pain, fever, and chills.

93.

A 67-year-old female patient with uncontrolled hypertension is admitted with hypertensive urgency. She reports a severe headache and blurred vision. Her blood pressure is 230/130 mmHg, her heart rate is 88 beats per minute, and she has no chest pain. 

Which of the following findings would MOST likely indicate progression to hypertensive emergency?

  • Development of pulmonary edema

  • Signs of left ventricular hypertrophy

  • Elevated serum creatinine

  • Presence of S4 heart sound

Correct answer: Development of pulmonary edema

The development of pulmonary edema is a sign of end-organ damage, which characterizes a hypertensive emergency requiring immediate intervention.

Left ventricular hypertrophy indicates chronic hypertension but is not specific to emergency progression. Elevated serum creatinine suggests kidney involvement but does not indicate an emergency unless acute kidney injury develops. An S4 heart sound can be heard in long-term hypertension but does not signify acute worsening to a hypertensive emergency.

94.

You are caring for a 32-year-old female patient with Graves' disease who presents with severe palpitations, tremors, and diarrhea. Her heart rate is 145 bpm, her blood pressure is 145/90 mmHg, and her temperature is 103°F. 

Which of the following interventions is most likely indicated FIRST?

  • Administer propranolol

  • Administer hydrocortisone

  • Begin intravenous fluid resuscitation

  • Administer levothyroxine

Correct answer: Administer propranolol

Beta-blockers (propranolol, esmolol) are indicated to control the cardiovascular effects of hyperthyroidism, such as tachycardia and palpitations, especially in a thyroid storm. They blunt the sympathetic nervous system receptors, helping to stabilize the heart rate while addressing the underlying hyperthyroid state.

Hydrocortisone is used in thyroid storms for adrenal support but is not the first-line treatment in this acute situation. Intravenous fluids may be needed for hydration, but controlling the heart rate and symptoms of thyroid storm is more urgent. Levothyroxine is used to treat hypothyroidism, not hyperthyroidism or thyroid storm, so it would not be appropriate in this context.

95.

A 55-year-old male patient with a history of atrial fibrillation is experiencing palpitations and dizziness. His ECG shows an Atrioventricular (AV) block. What is the MOST likely effect of an AV block on his heart function?

  • Impaired transmission of electrical impulses from atria to ventricles

  • Increased automaticity of the ventricles causing tachycardia 

  • Enhanced synchronization of atrial and ventricular contractions

  • Improved efficiency of ventricular ejection fraction

Correct answer: Impaired transmission of electrical impulses from atria to ventricles

An AV block impairs the transmission of electrical impulses from the atria to the ventricles, which can lead to symptoms such as palpitations and dizziness due to inefficient heart function.

Increased automaticity of the ventricles causing tachycardia is not related to an AV block but to ectopic pacemaker activity.

Enhanced synchronization of atrial and ventricular contractions is the opposite of what happens in an AV block, in which synchronization is actually impaired.

Improved efficiency of ventricular ejection fraction is not a result of an AV block; an AV block can reduce the efficiency of the heart's pumping action.

96.

Of the following clinical manifestations, which is LEAST likely indicative of a Hyperosmolar Hyperglycemic State (HHS)?

  • Kussmaul respirations

  • Severe hyperglycemia

  • Altered mental status 

  • Dehydration

Correct answer: Kussmaul respirations

Kussmaul respirations are more commonly associated with Diabetic Ketoacidosis (DKA) than with HHS. In HHS, patients typically do not develop metabolic acidosis, which is the cause of Kussmaul respirations in DKA.

Altered mental status is a characteristic finding in HHS due to the extreme hyperglycemia and subsequent hyperosmolarity. Dehydration is also a hallmark of HHS, resulting from the severe osmotic diuresis caused by the hyperglycemia.

97.

Which of the following statements is TRUE about Electrocardiography (ECG)?

  • On the calibrated graph paper used for ECG tracing, the horizontal axis measures time and the vertical axis measures voltage

  • On the calibrated graph paper used for ECG tracing, each small box on the horizontal axis is equal to 0.5 mV

  • On the calibrated graph paper used for ECG tracing, each small box on the vertical axis measures 1 mm and is equal to 1 mV

  • On the calibrated graph paper used for ECG tracing, the horizontal axis measures voltage and also represents mm of ST segment deviation

Correct answer: On the calibrated graph paper used for ECG tracing, the horizontal axis measures time and the vertical axis measures voltage

On the horizontal axis, which measures time, each small box is equal to 0.04 seconds, and each large box is equal to 0.20 seconds. On the vertical axis, which measures voltage, each small box measures 1 mm and is equal to 0.1 mV; each large box is equal to 5 mm or 0.5 mV. The vertical axis also represents mm of ST segment deviation.

98.

What is the MOST common initial symptom of Pulmonary Arterial Hypertension (PAH)? 

  • Dyspnea on exertion

  • Chest pain

  • Syncope

  • Cough

Correct answer: Dyspnea on exertion

Dyspnea on exertion is the most common initial symptom of PAH. As the disease progresses, this symptom may worsen, limiting the patient’s ability to perform daily activities.

Chest pain can occur in PAH due to right ventricular strain but is not the most common initial symptom. Syncope may occur in advanced stages but is not typically an early sign. Cough is not commonly associated with PAH and is more indicative of other pulmonary conditions.

99.

A 71-year-old male patient with a thoracic aortic aneurysm measuring 5.5 cm is being evaluated for surgical intervention. What factor is MOST likely to influence the decision to proceed with surgery?

  • Size and growth rate of the aneurysm

  • Patient's overall functional status

  • Presence of comorbid conditions

  • Patient’s age

Correct answer: Size and growth rate of the aneurysm

The size and growth rate of the aneurysm are the most critical factors in deciding whether to proceed with surgical intervention. An aneurysm measuring 5.5 cm is generally considered large enough to warrant surgery, especially if it is growing rapidly.

While the patient’s overall functional status is important, it is secondary to the risk posed by the aneurysm's size and growth. Comorbid conditions are also considered, but they typically influence the risk of surgery rather than the decision to operate. The patient’s age is a factor, but it is weighed against the immediate risks associated with the aneurysm itself.

100.

Of the following emergency measures, which is the LEAST likely to be implemented for Ventricular Assist Device (VAD) failure?

  • Initiate cardiopulmonary resuscitation

  • Have vascular clamps available for cannula disconnections

  • Cardiovert and defibrillate the patient with a VAD in place

  • Have a backup VAD in place and ready for operation in case a mechanical failure occurs

Correct answer: Initiate cardiopulmonary resuscitation

Cardiopulmonary Resuscitation (CPR) is the least likely intervention in the case of a VAD failure. CPR is generally not recommended for patients with a VAD unless the patient is unresponsive and pulseless and alternative methods to restore circulation have failed. The compressions could dislodge the device or cause other complications. Advanced providers will typically consider other measures first.

Having vascular clamps available is a crucial emergency measure in case of cannula disconnections or bleeding, ensuring that life-threatening blood loss can be quickly controlled.

Cardioversion and defibrillation can be safely performed in patients with a VAD in place, as these devices are designed to withstand electrical shocks. Therefore, if the patient experiences a dysrhythmia, this intervention might be necessary.

Having a backup VAD ready is essential in case of mechanical failure of the primary VAD. This ensures immediate replacement to maintain circulatory support.

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